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Tag Archives: anxiety

We’ve all experienced it. It’s that moment after the adrenaline of beginning your internship has worn off, the novelty of your coworkers and fellow interns is becoming rote, and your readings and papers for school are creeping up fast and furiously. Some of you may also hold a part-time or full-time job while juggling school and the internship. Your rose-colored glasses get darker and suddenly, you can’t remember the last time you smiled, laughed or ate something. Welcome to the Dark Days.

I only mildly exaggerate but there will come a point in time when things feel completely overwhelming. I wish there were a salve to rid us all of these days but this post exists to remind you that a) it’s normal and b) make time for self-care.

If you’re in the middle of it now, you may be rolling your eyes and thinking, what does she know? Trust me, I know! I was a full-time professional and student with a caseload of clients that demanded an immense amount of time and energy…I know what it feels like to not have the time to breathe. I also know that when you are experiencing exhaustion and the first signs of burnout, not only are you not doing any good for yourself but your work in the field may also suffer. I can’t emphasize enough the importance of self-care. It’s not just a concept in your textbook; it’s an important aspect of your development as a professional.

Self-care doesn’t always mean a two week stay at a beach resort with a Bahama-Mama at your side (though it sounds great!). It could mean taking 30 minutes in your day to do something for you. Stretch, journal, watch an episode of a funny show. Engage in anything that helps you reconnect to you and your interests outside of the counseling realm. (For more ideas, see this post featuring Shawn Achor)

Lastly, for those of us based in NY and surrounding states, Sandy has disrupted many of our lives. There are a number of resources available to help you and your clients address stress and trauma related to the storm.

Sometimes, interacting with clients feels a little like speed-dating. We meet, we chat for a bit, and suddenly I find myself wondering and worrying about whether or not they’ll call me again. Did they find our session helpful enough for round two? Am I the type of counselor they can see themselves with?

After a first meeting or particularly difficult session, a client cancellation or no-show prompts me to rewind back through the session in slow motion, searching for clues that might answer that persistent nagging question: “Was it something I said?”

I’m embarrassed that a missed session can so quickly bring down my carefully constructed fort of self-confidence. The cancellation/ no-show kicks up those still too-fresh grad school feelings of self-doubt and uncertainty. At best, I feel a little rejected. At worst, I fear I’ve scared them away from counseling altogether.

I had to face this recently when Calm Client missed not one, but two sessions in a row. Complete no-shows. No call, no text, no pigeon carrying a calligraphic notice. So, I did the normal thing and placed a phone call. No answering machine and no client. Then I did the abnormal thing and conjured up the last session (and the one before that) for a mental re-run. By the time I was done – none of it yielding any clues – the second week had come and again, a no-show. Well, I thought, I’ve really done it now. I called again but this time the number was no longer in service. I must have scared Calm Client right out of the state!

The following week, I was shocked to see Calm Client was waiting for me, a full 15 min before the scheduled session. The wave of relief that Calm Client was a) physically fine and b) present was overwhelming. I felt greedy to know what had caused the no-shows and I prayed it had nothing to do with me. The explanation was one of the best I could have ever hoped to hear. Calm Client had landed a new job and the change in schedule caused the missed sessions. Calm Client meant to call, but had not. And my second call attempt failed due to a change in phone service. The words from Carly’s song came to mind, “You’re so vain…” and yes, I did think that the no-show was about me. It wasn’t.

My take home lessons:

1. The cancellation/ no-show might not be about you.

2. Self-confidence is still a weak spot. As a new professional, it’s easy to fall into the mindset that perhaps you did something wrong or that you’re not very good. Keep building that brick house of self-confidence.

3. The cancellation might indeed be because of you…and now how do you prevent those negative feelings from causing you to run screaming from the profession?

While I work on the internal aspect of cancellations, I’m trying to take a proactive approach to managing cancellations.

Client Responsibility – When I meet with clients for the first time I stress the importance of calling in at least 24 hrs before the session if they cannot make it. Not only does it put some of the responsibility on the client but it serves as a way for me to check in on the client. I’m far less likely to feel anxious and get lost in the world of self-doubt if I can hear the client’s voice (their tone can tell you quite a bit) and provide a positive statement like: “I’m sorry we will not meet today but I look forward to seeing you next week.”

Assigning Homework – I don’t do this in every session, but sometimes a well-timed homework assignment can give clients that extra push to make it next week. Sometimes something as simple as, “You mentioned XX during the session and perhaps next week you can tell me more about it,” can provide the impetus for a client to return.

Charge a Fee – I’m not in private practice so I can’t implement this for my clients but some private practitioners and agencies will charge a fee for a no-show or cancellation less than 24-48 hours before the session. It’s not about beating the client over the head with fees but rather making it very clear that counseling services are indeed a service and a missed session without prior notification may cause a counselor to miss providing that service to another paying client. Charging a no-show or late cancellation fee certainly makes one reconsider blowing off the counselor for that re-run of any-old reality show.

End it with Positivity – Therapy can be tough. Anyone who has ever been a client can tell you there are days that you want to just melt into the couch and be done with the whole thing. I make it a point to leave some time at the end of a hard session to summarize and pull together pieces for the client, to acknowledge the difficulties faced during the session, and to appreciate the courage it took to engage fully. It instills a sense of accomplishment for sifting through the issues and as a reminder that therapy is a process and it’s not always easy but sticking with it can yield life changing results.

How do others proactively (or retroactively) deal with clients that cancel, don’t show, or simply never return?

My partner and I decided that the 94 degree weather on Sunday was the perfect weather for what he termed a “vigorous” hike. Vigorous indeed. The scramble up the first set of rocks confirmed three things.

Courtesy of Josh Giunta

I am out of shape.

I’d like to learn how to rock climb.

No, rock climbing is not one of my “hidden” talents (I believe I have some…I just have to figure out what they are, ergo the “hidden” part)

The hike lasted almost 5 hours and was mostly fun — except for the getting lost part. Sometime after lunch, just past the last rock scramble, we found ourselves off the trail, surrounded by tons of kamikaze bugs (one of which successfully landed in my eye), and kicking ourselves for not bringing the extra bottle of water. Luckily, “there’s an app for that” and we were able to get back on track before the sun went down.

The 40 minute detour provided a golden opportunity to reflect on what type of person I am in a hiking bind. I think there are four main types: Screamers, Frodos, Guides, and The Eaten. Humor me on this…

The Scream – Edvard Munch

The Screamer – 10-20 minutes of being lost, this is usually the person that starts to shiver before erupting into an oxygen-deprived wail that may last anywhere from a few seconds to hours. Their shouts may include a mix of both optimistic cries (“Somebody, help us!) and pessimistic sentiments (“We are all going to die!). You can count on the Screamer to relay the obvious (“This riverbed is completely dry!”) and alert the group to unknown dangers (“I heard a growl from over there!”) As frustrating as Screamers might seem, I think they serve a crucial purpose as they are able to both inform anyone in the area of a) the situation and b) the status of the group. This comes in particularly handy if you have the next type in the group.

The Frodo – For those of you familiar with Lord of the Rings, you may recall Frodo as being the brave Hobbit who carries the burden of The Precious with little more than the occasional yelp of pain or sigh of discontent. While hiking, Frodos will not complain much as they plow through uncharted territory and their lack of speaking up may add some sense of calm to an otherwise stressful situation but, you often won’t notice the Frodo until s/he has collapsed 50 yards behind the group. They’re generally not a pretty sight at the end of the ordeal.

The Guide – This type is pretty self-explanatory. Guides will often take command of the situation with varying degrees of success. I think there are a number of sub-types within Guides, ranging from the Democratic Guide who attempts to utilize a voting system within the hiking party, the Cheerleader Guide who provides frequent check-ins and updates on progress to the group, to the Vigilante Guide who will make quick decisions and spit bark and anyone who stands in the way. Of course, there are always the Directionless Guides who have no sense of what to do but continue to move the group – possibly in circles – just for the sake of doing something. In general, Guides tend to be quite useful…until they’re not.

The Eaten – (I’m using the term tongue-in-cheek here.) This is less of a type and speaks more to the outcome of what happens when any one type takes it too far. There are probably some other contributing factors including but not limited to: BMI score, fighting skill, and general likability but, overall I think the types that fall into this category can be decided upon by the following formula:

Overall, my experience in the mountains allowed for some interesting insights. I recognized that I’m more of a Frodo-type and that speaking up sooner rather than later might be a good trick to learn (silently trying to conquer a fear of falling while on a hot rock only leads to burnt palms). Partnered with a Cheerleader Guide, the experience was far less stressful than it could have been were I lost in the woods with any of the other types. While it takes “all kinds” there are some folks I would prefer not be lost in the woods with. I plan to hike it again and will remember the following:

The past few months have brought more than a fair share of events that have required adaptation and coping – the quick and painful kind. There have been major events in virtually every aspect of life. Each one bringing a heaping serving spoon of stress. Enter sleep issues, teeth clenching, the nothing-pie and air-soup laying claim to my appetite.

There are situations that actually do warrant the type of reactions that I would normally attempt to steer myself away from. All in all, I’d say I’m not coping too poorly. Not staying in bed all day, not missing work, not consuming anything “unsavory”, not weeping in a heap on the subway. On a scale of 1-10 for functionality, I’d give myself a solid 8.

But, still.

There are situations that are not fleeting. They linger and shift and change shape even as I struggle to get them into a solid grasp. The idea of more change – more reasons to adapt and cope – makes the room spin, lights dim, and I fall with Alice-like abandon into a dark unknown.

Life events – positive, negative, external or internal – can present opportunities for new and exciting revelations; but, when too many things are in “transition” it can quickly turn into a rabbit hole. But, still.

In all of the personal turmoil, there still needs to be the energy and mental wherewithal to work and be of use to clients. I appreciated Suze Hirsh’s account of “emotional shock” in a recent edition of Counseling Today and how to stay steady when distracted by our own issues. They involve many of the same techniques we might provide to Fly off the Handle Client. I had a chance to use some of her wisdom when Weepy Client boldly stated that I have probably not experienced any hardships in my life. I’m not sure what gave Weepy Client that impression but while my initial reaction was to retort with a fierce verbal karate chop, I followed Hirsh’s recommendations and breathed deeply, tapped on my clavicles (though maybe not as inconspicuously as she suggests) and was able to respond in a manner expected of a counselor. It made all the difference. Thank you, Suze!

Every once and a while, feeling that flash of anger or having a sleepless night is pretty normal (I’ve learned too that, a bowl full of cherries, mug of chamomile, and March of the Penguins seems to do the trick for getting to sleep). Coping in and of itself requires adaption. It’s constantly in-motion and evolving.

Life will throw tacks in the road – figuring out how to navigate between them is part of the trip. How do others cope with stress and stay calm in the professional arena?

Graduate School Separation Anxiety. It doesn’t exist in the DSM-IV TR (though I’m not sure if it’s proposed in the DSM V alongside Bad Baby Syndrome and Fantasy Football Disorder) but it certainly feels real. I put in a solid 6 semesters (including juggling work, fieldwork, and everyday life) yet now at the bitter end, I find myself looking at the course schedule for next term. There’s not supposed to BE a next term for me. I’m done. Over and out. So what is this feeling that is intruding upon the merriment that is supposed to come with graduation? GSSA.

For two years I have been a student. Granted, I’ve been a student before and may be one again, but “student” is a title that grants a sense of knowing what will come next. After Fall term, comes Spring. After X class, comes Y. Leaving “student” behind…well what comes next? There’s a few things to check off the list like the license test, applying for the limited permit, obtaining a job, accruing hours, etc. Yet there’s a lack of overarching structure that is lost once exiting the world of “student’ that can be downright terrifying and makes that next semester look mighty good.

The cure for GSSA? Rather than considering it a “letting go” of the safe haven of school, I’m trying to re-frame it as embracing the *new* professional I am about to become. It’s a different feeling for me – as a career switcher – to leave the comfort of the known but it’s an exciting move and a time to accept the pat on the back for a job well done and recognize that completing grad school (albeit, again) is an accomplishment. So, to all the other students who are about to shed that title, I wish you the best! Polish up the resume, hit the streets, and get ready for the ride of your life.